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Being linked in to treatment and
care services – with regular health monitoring and prompt treatment of health
problems – is an important part of staying well with HIV. How HIV care is
delivered varies significantly from region to region. Its efficacy is often
affected as much by perceptions of the benefits of care as by limitations in
local healthcare systems. New models of care, especially in resource-limited
settings, aim to encourage people living with HIV and those at risk of
infection to access and stay in care, while not placing an unsustainable strain
on healthcare services.
A study undertaken in rural
KwaZulu-Natal, South Africa, has looked at the reasons why people stay or are
lost from care following an HIV diagnosis. The participants had all been
diagnosed through a home-based HIV counselling and testing service (HBHCT).
The study found that younger age,
not believing HIV test results, and believing that anti-HIV drugs make you
sick, were all associated with people being less likely to be linked to
healthcare services. Living in a household with more than two adults, having
difficulty finding time to seek medical care, and drinking alcohol were all
also linked to not accessing care.
People who believed that they would
be able to get the drugs and other supplies they needed at their local health
facility, and those who experienced more than three symptoms of depression
after their HIV diagnosis were more likely to access and stay in contact with
care services.
The scheme being studied was
developed as part of national efforts to increase awareness of HIV status, by
shifting towards community-based models of HIV testing. Schemes such as these
work best when people diagnosed with HIV are linked to care immediately after
diagnosis, and are able to start HIV treatment at the right time. Achieving
this can be a challenge.
The researchers suggest that
community-based health services and flexible opening hours at healthcare
facilities would help people access and stay in care. Increasing awareness of
newer anti-HIV drugs – which have fewer serious side-effects than the previous
most commonly used drugs – could also help.
A second study, from Uganda, found
that people who were divorced, widowed or currently married were more likely to
be in care than people who were single. Other social and demographic factors
such as level of education, gender and age did not seem to be linked to being
in care.
New models of care are not
restricted to resource-limited settings. A community testing centre in
Barcelona was the service where a third of all gay men newly diagnosed with HIV
in Catalonia, Spain, had had their test, the conference heard. Almost all these
men were then linked to treatment services.
The project, BCN Checkpoint, was one
of the first community testing centres for gay men in Europe. Rapid,
point-of-care tests are delivered by non-medical staff and volunteers, also
offering peer-led, ‘sex-positive’ counselling. In Spain, HIV testing is
generally offered in primary care – that is, by general practitioners or family
doctors. Not all these doctors are experienced or comfortable supporting gay
men with sexual health.
BCN Checkpoint is reaching gay men
at high risk of HIV infection, with men coming to test for the first time and
coming back for repeat tests. There is a concern that people diagnosed with HIV
at community-based services might not go on to access HIV care. BCN Checkpoint
offers peer support to newly diagnosed men, provided by a member of staff or
volunteer who is also HIV positive. The service can also arrange an appointment
with a specialist HIV doctor and, if necessary, help with paperwork to access
public health care.
Over 90% of newly diagnosed men were
accessing care with the help of the project, and only 2.4% were lost to
follow-up.
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus.
To learn more about The Friends of
AIDS Foundation, please visit: http://www.friendsofaids.org.
TOGETHER WE REMAIN STRONG!
